• Abstract and Figures
• Public Full-text

DISCUSSIONS WITH LEADERS A Conversation Between Markus Schwaiger and Johannes Czernin Markus Schwaiger1 and Johannes Czernin2 1Technische Universit¨at M¨unchen, Munich, Germany; and 2David Geffen School of Medicine at UCLA, Los Angeles, California my research career with an interna- Markus Schwaiger has been Medical Director at the univer- tional stipend, which allowed me to sity hospital ‘‘Klinikum rechts der Isar’’ of the Technical Univer- spend 1 year in Cincinnati (OH) sity of Munich (TUM) since 2016. From 1993 to 2017 he was working in physiology. This 1-year Director of the Clinic and Polyclinic of Nuclear Medicine. His fellowship initiated my interest in main area of research is the use of multimodal imaging to visu- cardiovascular sciences, because I alize and quantify biologic processes. His research involves the studied the vascular effects of hista- use of PET in cardiology and oncology. He is Director of the mine in the mesenteric circulation. German Research Foundation’s Collaborative Research Center After returning to Germany I started 824, which deals with molecular imaging for selecting and mon- out as a cardiac surgeon—but not for itoring oncologic therapies. Diagnosis and treatment of thyroid long. I switched over to cardiology endocrine and neuroendocrine diseases are also of special interest. and began a combined program of Markus Schwaiger, Dr. Schwaiger studied medicine at Freie Universit¨at Berlin and internal medicine and cardiology at MD Freiburg University. His career as a doctor and researcher has the German Heart Center in Munich. Dr. Czernin: taken him to the University of California Los Angeles (UCLA) And this is when your research career started? School of Medicine and the University of Michigan (Ann Arbor), Dr. Schwaiger: I started in the area of nuclear cardiology with radio- as well as other academic sites. He is a member of the Bavarian nuclide ventriculography (RNV) and myocardial scintigraphy. At that Academy of Sciences and the Deutsche Akademie der Naturforscher time, RNV was the only method to measure cardiac function noninva- Leopoldina. He has an honorary doctorate from the University of sively, so as a young cardiologist I was quite excited. Subsequently, the Varna, Bulgaria. role of myocardial metabolism attracted my attention, because we became Dr. Czernin: I want to start out with a bit of your biography. interested in learning how the mechanical performance of the heart was You studied medicine at the Freie Universit¨at Berlin in the 1960s. supported by energetics. I was told that there was a new ‘‘machine’’ in the That was at a time when many people would not have focused on United States that allowed noninvasive measurement of cardiac metabo- studying but instead were on the streets demonstrating. What was lism. This was the beginning of cardiac PET. I went to UCLA to visit the climate at the university at that time? Heinz Schelbert and became extremely excited about emerging research 18 11 Dr. Schwaiger: It was definitely a climate of change. The Ger- possibilities using metabolic imaging with F-FDG and C-palmitate. I man so-called ‘‘68 movement’’ was a primarily student-driven re- must admit I was even more enthusiastic about the idea of living in action against the authoritarian structures of German society in Westwood near Santa Monica. Retrospectively, my decision to move to general and in particular against the rigid structures at universities. LA turned out to be a very positive step, because, as you know, UCLA Discussions focused on liberation from traditional, hierarchic struc- has been an outstanding environment for many young German car- tures, following mostly left-wing ideologies. This political reorienta- diologists. I had access to new resources we did not have at home. In tion was part of the German recovery process from the Hitler regime addition, the academic freedom at American universities, along with and World War II. At the university level, students petitioned to be the support and excellent training provided by leaders in the field, part of academic decision-making bodies defining areas and content represented an ideal start for my research in cardiovascular imaging. of curricula. It was a very interesting and challenging time for me Dr. Czernin: And then you did all the pivotal early viability personally, coming from a well-preserved bourgeois environment in studies with Heinz? Munich. We all needed to define our own political position in very Dr. Schwaiger: I learned to do animal experiments in Cincinnati, unstable times. Retrospectively, it is important to note that the student because we worked on the functional characterization ofhistaminere- protests started off many reforms in German society and universities. ceptors in dog models. So I was quite familiar with experimental models Maybe the students were a little bit too loud at the time, but the and enjoyed combining preclinical with clinical research. When I started results had significant impacts on democratic processes in Germany. at UCLA, I wanted to use PET imaging to characterize experimental Dr. Czernin: What happened after medical school? models of ischemia and reperfusion. This was the time when recanaliza- Dr. Schwaiger: I moved back to Munich, where I was born. I tion of the coronary arteries in the setting of acute myocardial infarction did my early clinical training there and completed my doctoral became the favored strategy to rescue myocardial tissue. The pioneering thesis on vector electrocardiography. During that time, I started research of Dr. William Ganz in this area at Cedars-Sinai (Los Angeles, CA) inspired me to follow this direction. We hypothesized that PET imaging would be useful to predict myocardial recovery after tran- COPYRIGHT © 2019 by the Society of Nuclear Medicine and Molecular Imaging. sient ischemia. Indeed, we observed that increased 18F-FDG uptake in DISCUSSIONS WITH LEADERS • Schwaiger and Czernin 573 ischemic areas was a signal of viability, as evidenced by subsequent environment in which everyone must have insurance coverage. The functional recovery. This experimental work was part of a larger research ‘‘hybrid’’ German system also includes private insurance for high-income program at UCLA that defined the role of PET in clinical identification groups with broader coverage. The bottom line is that everybody has free of viable myocardium in the setting of advanced ischemic heart disease. choice of physicians and access to all aspects of the German health care Dr. Czernin: After a long and very fruitful collaboration with system without restrictions. On the other hand, German health care Heinz Schelbert you left UCLA in 1987 and moved to Michigan. providers face the problem that services are ‘‘capitated.’’ This means that Dr. Schwaiger: This was a difficult decision, because I really physicians and hospitals work within predefined budgets that are nego- enjoyed UCLA and I had just finished my cardiology fellowship there. tiated with insurance companies. The result of this capitation is that the I was offered a position in the Division of Cardiology and Nuclear cost of German health care is about half that in the United States. The Medicine. But at the same time I felt that it might be better for me to system is efficient, but resources are restricted, especially for academic start my own independent research group. At this time, Michigan ex- institutions. For example, the role of clinician scientists at academic celled with a very prominent cardiology program headed by Dr. Bertram centers is much less developed than in the United States. At German Pitt. Dr. Eric Topol, Dr. Cindy Grines, and many others were recruited to institutions research is usually done after hours, because physicians are focus on innovative ways to treat acute myocardial infarction. This was primarily engaged in clinical services. In addition, structures in German scientifically a very exciting time, because cardiology changed from a academic institutions are quite hierarchic. Each department is directed by conservative to a very ‘‘aggressive’’ discipline based on intervention in 1 chair, and everyone else serves this chair. This leads to a much more treatment of coronary artery disease. We were all excited to be part of vertical organization than in the United States. The advantage is, I have to the rapid changes leading to interventional cardiology. Nuclear cardiol- admit, that one has a high degree of freedom when at the top of this ogy was in many aspects an important part of this process. hierarchy. In recent years, several changes have been made to adapt the Dr. Czernin: You stayed there for 6 years and were then offered German structure to the increasing need for protected research time. the chair position at the Department of Nuclear Medicine at TUM. Overall, I think both the U.S. and European systems have their Dr. Schwaiger: I had the opportunity to go back to Munich. strengths and limitations as far as research is concerned. However, After many discussions, we decided as a family to return to Ger- I am convinced that the United States provides a more attractive many. I was very optimistic about taking all of my very positive academic environment, whereas Europe excels in very efficient experience in the United States back to Europe. overall health care for most members of society. Dr. Czernin: This leads us to the focal point of the discussion that Dr. Czernin: When you talk about capitation in Germany what I would like to have with you. In Munich, you served as chair, then do you mean? The patient has insurance, and he or she has to pay became dean of the medical school in 2002 and medical director of into this system. ``Overall, I think both the U.S. and European systems have their strengths and limitations as far as research is concerned. However, I am convinced that the United States provides a more attractive academic environment, whereas Europe excels in very efficient overall health care for most members of society.’’ the hospital in 2017.

Load more

  4

Copy Link